Menopause and the belly: an endocrinologist explains when bloating is gas, when it's water, and when it's fat tissue quietly driving inflammation

"It's your age." The sentence many women over forty hear when they say their belly is bloated, that their trousers are suddenly tight, that something isn't the way it used to be. Madrid endocrinologist Celia Gonzalo Glaze offers a better answer: menopause really does change the belly, but not all bloating comes from hormones - and that difference is exactly what matters.

What's actually happening. In perimenopause the ovaries work irregularly and progesterone falls, which can slow digestion. Oestrogen fluctuates and affects how much water the body retains. But bloating can also be caused by constipation, certain foods or a sensitive gut. That's why the doctor warns: "Bloating that is new, persistent or getting worse should not automatically be attributed to menopause."

The fat you can't see. Less oestrogen means fat tissue is more easily deposited around the organs - this is visceral fat. It's linked to chronic low-grade inflammation and lower insulin sensitivity. The problem is that this inflammation has no clear symptoms and, according to the doctor, can't be diagnosed by how the belly looks. Gas, bloating and water retention are one thing. Systemic inflammation is something else entirely.

How to tell them apart. Bloating from gas changes over the course of the day and is worse after a meal. Retained water often shows on the hands and ankles too, with quick changes on the scales. Belly fat grows slowly and stays - the waist gradually gets wider. At the doctor's, the assessment can include a body composition scan, such as DXA, which estimates visceral fat.

What helps. Eating slowly, avoiding oversized meals, fewer fizzy drinks. Working out which foods or sweeteners bloat you - but without cutting out whole food groups without expert advice. With constipation, increase fibre gradually, with enough water. If you retain water, less salt and alcohol. Muscle is protected with enough protein and strength exercise, and a walk after a meal helps digestion. The target: 150 to 300 minutes of moderate aerobic activity a week and strength exercises on at least two days a week.

When not to wait. Bloating that appeared suddenly, lasts several weeks or gets worse - especially after fifty - and comes with feeling full quickly, pain in the belly or pelvis, a wider waist or more frequent urination, needs an examination. The same goes for unintentional weight loss, blood in the stool, lasting changes in bowel habits or vaginal bleeding after menopause. Swollen legs with shortness of breath need urgent checking. Constipation, coeliac disease and an underactive thyroid are also among the causes that should be ruled out.

How many times has "it's your age" been the end of the conversation rather than the start? Menopause isn't a disease, but it isn't an excuse that covers everything either. A changing belly is a reason to ask a question - and to find a doctor who asks the right one.